| NPI | 1861481699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38146-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 20020452) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2011-06-10 |